The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

INO for Sickle Cell Crisis

Dean R. Hess, PhD, RRT, FAARC Massachusetts General Hospital, Boston, Massachusetts

Sickle cell disease is characterized by acute pain crisis and acute chest syndrome. There is interest in the use of inhaled nitric oxide in the treatment of these aspects of sickle cell disease. Inhaled nitric oxide may be beneficial during acute pain crisis because it shifts the oxyhemoglobin dissociation curve (resulting in less polymerization), or because it enhances nitric oxide delivery to the peripheral circulation (resulting in less vaso-occlusion), or because it decreases the activity of vascular adhesion molecules. Several published case studies have also reported benefit from inhaled nitric oxide in acute chest syndrome.
Objectives
1. Compare acute pain crisis and acute chest syndrome in sickle cell disease
2. Describe the oxyhemoglobin dissociation curve of patients with sickle cell disease
3. Describe the role of hemoglobin in nitric oxide transport
4. Discuss the potential mechanisms of inhaled nitric oxide in sickle cell disease
5. Discuss the potential role of inhaled nitric oxide in acute chest syndrome
Outline
A. Overview of sickle cell disease
1. Acute pain crisis
2. Acute chest syndrome
3. Treatment
B. Potential mechanisms of inhaled nitric oxide in sickle cell disease
1. Shift of oxyhemoglobin dissociation curve
2. Increase nitric oxide transport to periphery
3. Decreased activity of vascular cell adhesion molecules
C. Inhaled nitric oxide with acute chest syndrome

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